Reintervention and mortality after infrainguinal reconstructive surgery for leg ischaemia

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Abstract
Background: Progression of atherosclerosis and graft-related complications are common indications for late vascular intervention. The aim of this study was to determine the cumulative risk of late reintervention or death after infrainguinal bypass grafting. Methods: Some 205 consecutive patients with limb-threatening ischaemia were included. All data were recorded prospectively. The principal endpoint was reintervention for a graft-related complication or recurrent leg ischaemia. Mean follow-up was 3·3 years. Life-table and multivariate analyses were employed to estimate the cumulative risk of reintervention or death during follow-up and to assess factors influencing this risk. Results: Beyond 30 days after insertion of the infrainguinal bypass, 67 patients (33 per cent) had 112 subsequent vascular interventions in the ipsilateral extremity. The cumulative reintervention rate was 25 per cent at 1 year and 40 per cent at 5 years. Poor run-off (P < 0·005) and prosthetic grafts (P < 0·001) were significant and independent risk factors. Long-term survival was poor and affected by the presence of diabetes (P < 0·01) and renal insufficiency (P < 0·01). Conclusion: Late reinterventions are common after infrainguinal bypass for limb-threatening ischaemia, and contribute to morbidity and discomfort. Such information is of particular relevance to patients in high-risk groups and should be explained as an integral part of informed consent.